Provider Demographics
NPI:1699905810
Name:SMITH, KATRINA (MS CCC SLP)
Entity type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:JOY
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2106 N PONCA DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64058-1251
Mailing Address - Country:US
Mailing Address - Phone:573-529-1721
Mailing Address - Fax:
Practice Address - Street 1:2106 N PONCA DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64058-1251
Practice Address - Country:US
Practice Address - Phone:573-529-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist